UNDERWRITING PHILOSOPHY

Underwriting philosophy for offering Insurance coverage to persons with Disability and Mental Illness

Introduction:

Following is broad underwriting philosophy to offer health insurance coverage to Person with Disabilities and Persons with Mental Illness. To make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. The philosophy is made with large principle of ensuring that there is no discrimination bias and adhering to the provisions under the Mental Health Act 2017.

“Mental Illness” as defined in DSM5 and ICD10 Refers collectively to all diagnosable mental disorders health conditions involving

• Significant changes in thinking, emotion and behavior
• Distress or problems functioning in social, work or family activities

Types of Disabilities:

• Physical disability- disability pertaining to person’s mobility- Level of disability
• Intellectual or Learning Disabilities
• Psychiatric disabilities
• Neurological disabilities
• Visual or hearing impairments

The following information will be considered while underwriting the proposal for health insurance with disability and/or mental illness. The underwriting practice for these illnesses is in line with the underwriting practices followed for any other medical conditions (eg: Heart disease, lung disease etc.)

Below information will assist the Underwriter in fair risk assessment and unbiased underwriting decision on the proposal

• Exact medical diagnosis, cause, and duration of illness, and its progress
• Treatment modalities since inception of the medical condition, including previous medical conditions.

Proposal would be evaluated based upon board approved underwriting guidelines for making an objective decision.

In cases, where objective criteria are not defined in the guidelines, such proposal are underwritten basis medical assessment and case merits specifically without discrimination or bias by medical panel of the company.

Mental health disorders are syndromes characterized by significant disturbance in a person’s cognition, emotional regulation and behavior resulting from a disturbance in psychological or biological or developmental processes that reinforce mental functioning.

Determinants for severity of the condition are multifactorial

• Age of onset
• Duration of the treatment
• Treatment response
• Co - morbid conditions

Risk factors that are considered for mental health disorders are

• Previous medical and family history
• Duration of illness
• Co morbidity
• Dual diagnosis
• Substance abuse
• Compliance with treatment

Actual Selection criteria for each condition depends on variability of presentation

Underwriting philosophy for offering Insurance coverage to persons affected with HIV/AIDS

The philosophy is made with large principle of ensuring that there is no discrimination bias and adhering to the provisions of HIV and AIDS Prevention and control Act, 2017.

To ensure fair underwriting decision, the following information will be considered while underwriting the proposal for health insurance from applicants affected by HIV/AIDS.

• Detail record of treatment and medical history.
• Confirmation of diagnosis with Stage of Disease
• Medical examination and blood tests as required under the product and underwriting guidelines
• Details of past medical history
• Details of co-morbidities and Systemic complications

The approach is to ensure that every application is underwritten on merit based on the guidelines under the underwriting policy and there is no discrimination in granting Health insurance coverage to people affected by HIV/AIDS. The acceptance of risk will be based on objective underwriting criteria and basis the risk represented, ensuring that there is no moral hazard. While the evidence based underwriting guidelines of the company, which is approved by the board of the company will form basis for making an objective decision.

Underwriting philosophy of offering Health Insurance Coverage to Transgender persons

Any proposal from transgender is evaluated like any other proposal for Insurance coverage. 

The following information will be considered while underwriting the proposal for offering Insurance coverage to transgender persons. This will assist the Underwriter in fair risk assessment and unbiased underwriting decision on the proposal.

Past medical records (if any) of surgery or medical/hormonal treatment/ Psychological assessment and health check reports are obtained as per the disclosed medical condition.

Disclosed medical conditions and the proposal would be evaluated based upon board-approved underwriting guidelines for making an objective decision to offer Insurance Coverage.